Eradication of hepatitis C virus and non-liver-related non–acquired immune deficiency syndrome–related events in human immunodeficiency virus/hepatitis C virus coinfection

Abstract

We assessed non-liver-related non–acquired immunodeficiency syndrome (AIDS)-related (NLR-NAR) events and mortalityin a cohort of human immunodeficiency virus (HIV)/hepatitis C virus (HCV)–coinfected patients treated with interferon(IFN) and ribavirin (RBV), between 2000 and 2008. The censoring date was May 31, 2014. Cox regression analysis was per-formed to assess the adjusted hazard rate (HR) of overall death in responders and nonresponders. Fine and Gray regressionanalysis was conducted to determine the adjusted subhazard rate (sHR) of NLR deaths and NLR-NAR events consideringdeath as the competing risk. The NLR-NAR events analyzed included diabetes mellitus, chronic renal failure, cardiovascularevents, NLR-NAR cancer, bone events, and non-AIDS-related infections. The variables for adjustment were age, sex, pastAIDS, HIV transmission category, nadir CD41T-cell count, antiretroviral therapy, HIV RNA, liver fibrosis, HCV genotype,and exposure to specific anti-HIV drugs. Of the 1,625 patients included, 592 (36%) had a sustained viral response (SVR). Aftera median 5-year follow-up, SVR was found to be associated with a significant decrease in the hazard of diabetes mellitus (sHR,0.57; 95% confidence interval [CI], 0.35-0.93; P 5 0.024) and decline in the hazard of chronic renal failure close to the thresh-old of significance (sHR, 0.43; 95% CI, 0.17-1.09; P 5 0.075). Conclusion: Our data suggest that eradication of HCV in coin-fected patients is associated not only with a reduction in the frequency of death, HIV progression, and liver-related events, butalso with a reduced hazard of diabetes mellitus and possibly of chronic renal failure. These findings argue for the prescription ofHCV therapy in coinfected patients regardless of fibrosis stage.